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Contact Information

FORT VALLEY STATE UNIVERSITY
1005 STATE UNIVERSITY DR
FORT VALLEY, GA31030-4313
 Phone: 478-825-6195
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Sports Medicine

207RS0010X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for FORT VALLEY STATE UNIVERSITY · (Female)

NPI Number 1457737769
Status Active
Credentials
Entity Individual
Enumeration date 08/10/2015
Last updated 08/10/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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